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Application of Interventional Radiology. Paul Byra, MIV USC-SOM. Angioplasty w/ vascular stenting Angiography Embolization CTA Cryotherapy Endovenous ablation of varicosities MRA MR guided biopsies Radiofrequency ablations of tumors. Thrombolysis

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Presentation Transcript
procedures performed
Angioplasty w/ vascular stenting

Angiography

Embolization

CTA

Cryotherapy

Endovenous ablation of varicosities

MRA

MR guided biopsies

Radiofrequency ablations of tumors

Thrombolysis

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Ultrasound guided biopsies

Uterine fibroid embolization

Vascular access procedures

Vertebroplasty

Biliary drainage and stenting

Fallopian tube catherization

Gastrostomy tube insertion

Urinary tract obstruction

Procedures Performed

And many more…

case 1
Case 1
  • 60 y.o male w/ hx sig. for HTN, NIDDM, and 80 pack year smoking hx who presents with signs of claudication
  • Bilateral femoral, right popliteal, dorsalis pedis, and posterior tibial pulses present
  • No palpable popliteal, dorsalis pedis, posterior tibial pulses present on the left
catheter angiography
Catheter Angiography
  • Image blood vessels for disease, narrowing, occlusion, or aneurysms
  • Catheter is threaded through the vascular system to area of interest
  • Contrast is injected and visualized radiographically
catheter angiography5
Catheter Angiography

Left common iliac stenosis

Not pictured superficial femoral and proximal popliteal artery occlusion

catheter angiography6
Catheter Angiography

Left iliac angioplasty and stent placement

catheter angiography7
Catheter Angiography

Post stent placement

case 2
Case 2
  • 30 y/o female with 16 week sized uterus
  • Negative UPT
  • Ultrasound significant for uterine fibroids
  • MRI of uterus 
  • White arrows indicate the fibroids
uterine fibroid emoblization
Uterine Fibroid Emoblization
  • Arteriogram is performed, identifying fibroid vessels
  • Embolization is performed on one side until near stasis is achieved, then the other side is embolized
  • Normal myometrial vessles are spared
uterine fibroid emoblization10
Uterine Fibroid Emoblization
  • 3 months S/P embolization
  • Uterine volume decreased by 66%
case 3
Case 3
  • 50 y/o male with hx of Chronic Hepatitis and portal hypertension causing severe variceal bleeding
  • Patient is on beta-blocker and has failed sclerotherapy
slide12
TIPS
  • A catheter is placed in the right jugular vein
  • The catheter is threaded through the superior and inferior vena cava to the hepatic vein
  • Wall of the hepatic vein is punctured and the needle is directed across an approximate 2 inch gap to the portal vein.
  • Successful passage into the portal vein is determined by the pattern of dye injected through the catheter
slide13
TIPS
  • A guide wire is threaded through the needle to maintain the passage between the hepatic and portal veins.
slide14
TIPS
  • A balloon may be used across the passage to widen the holes in the vessel walls and the passage through the liver tissue
slide15
TIPS
  • Two stents are then positioned along the passage, overlapping in the liver tissue and extending into both veins.
  • The stents are opened to their maximum width with balloon dilation
  • Blood flow from the portal vein across the stents to the hepatic vein and on to the vena cava is confirmed with dye injection.
case 4
Case 4
  • 72 y.o female with history significant for HTN, hyperlipidemia, and DM develops in the early afternoon a sudden, severe headache that is followed by left sided weakness of the arm and leg
  • Patient arrives to the ER 3 hours post-onset of symptoms
  • CT indicates nonhemorrhagic stroke
  • Patient’s BP 150/90, plt count >100k, normal bld glc; w/o history of intracranial hem., recent stroke or head trauma, recent MI, anticoagulation therapy, major surgery w/in past 14 days, or seizure during stroke
  • Basically no contraindications to tPA therapy but…it has been over 3 hours…hmmm…
thrombolysis
Thrombolysis
  • When therapy cannot be initiated within three hours or when treatment with tPA during the first three hours is not sufficient to dissolve the blood clot, interventional neuroradiologists can provide intra-arterial thrombolysis treatment
  • Using x-ray guidance, an IR will insert a catheter through the femoral artery to the artery where the clot is present and will place the thrombolytic drug directly on the clot or break up the clot mechanically
  • When given locally this way, the tPA can be administered up to six hours after the onset of stroke symptoms
thrombolysis18
Thrombolysis
  • CTA shows cutoff of right middle cerebral artery

CT perfusion images show decreased cerebral blood

volume and cerebral blood flow with mean transit time

representing ischemia.

thrombolysis19
Thrombolysis
  • Initial angiogram shows the middle cerebral artery cutoff
  • Road map angiogram shows the microcatheter crossing the clot before administration of tPA and microwire manipulation
thrombolysis20
Thrombolysis
  • At admission
  • Post thrombolysis angiogram
references
References
  • Society of Interventional Radiology. SIRweb.org
  • “Transjugular Intrahepatic Portosystemic Shunt”. University of Michigan Gastroenterology. http://www.med.umich.edu/1libr/aha/umliver09.htm
  • Interventional Neuroradiology. Massachusetts General Hospital. http://www.mgh-interventional-neurorad.org
  • Peripheral Vascular Disease. University of Toronto. http://surgclerk.med.utoronto.ca/